Upper-airway obstruction after multilevel cervical corpectomy for myelopathy

We reviewed the cases of seven patients who had had obstruction of the upper airway immediately after an anterior procedure on the cervical spine and had required reintubation. All patients had had moderate or severe myelopathy preoperatively (average, 3.6 on the Nurick scale), and all had had a multilevel anterior cervical corpectomy for decompression followed by arthrodesis. The early compromise of the upper airway was believed to be due to edema rather than to the formation of a hematoma. Five patients had no sequelae, but two died of complications related to the obstruction. Risk factors common to these patients included moderate or severe myelopathy and multilevel corpectomy. Six patients had a history of heavy smoking and one, of asthma. We believe that extra caution should be used in the postoperative management of the airways when multilevel corpectomy is performed in patients who have these pre-existing conditions.